Suicide contagion in the age of social media

Much has already been written in reaction to Robin Williams’s untimely death, about his incandescent talent, his prolific career, his decency and kindness, his addiction and his mental illness. His death robbed his fans of many more years of his genius and, of course, inflicted permanent grief on his loved ones.

In Johann Goethe’s 1774 novel The Sorrows of Young Werther, the protagonist shoots and kills himself after the woman he loves marries another man. The novel became very popular. In the following years many young men in Europe committed suicide by dressing precisely as Werther is described in the novel and shooting themselves. The concept of suicide contagion was first described at that time, the idea that the romantic or idealized description of a suicide could trigger suicide in a susceptible person.

In the 1980s the media in Vienna was abuzz with extensive and dramatic coverage of the deaths of people who jumped in front of subway trains. In 1987 an educational campaign alerted reporters to the possible phenomenon of suicide contagion. The reporters were asked to use more neutral, less dramatic language, and to focus more on the victims’ lives rather than on the details of their deaths. In the subsequent six months, subway suicides and non-fatal suicide attempts dropped by more than 80%, and the total number of suicides in Vienna also decreased.

No one suggests that these stories cause suicide in mentally healthy readers. The victims of suicide contagion are clearly depressed and may already be suicidal. The theory is that stories that make suicide seem very prevalent, heroic or romantic give permission to suicidal readers to act on their impulse.

The magnitude and specific mechanism for this effect is, of course, difficult to study. Randomized studies obviously can’t be done, and some researchers argue that the evidence for suicide contagion is overblown. Nevertheless, mental health professionals and public health officials have compiled recommendations for journalists covering stories of suicide, especially of celebrities. The press has largely followed these recommendations.

Enter social media. The wonderful thing about social media is that it allows anyone to broadcast their ideas to countless others. That’s also the terrible thing about social media. Social media has reminded us of all the negative consequences of free speech, from false rumors, to hate speech, to cyberbullying (most recently of Robin Williams’s daughter). And because the public hasn’t been educated to consider suicide contagion, we inadvertently spread potentially dangerous messages.

A tweet about Williams’s death that I’m sure was well-intentioned and seems sympathetic and sweet, nevertheless would never have made it past a professional reporter or editor writing about suicide. That’s because it makes suicide seem like a poignant escape, a freeing act, an option. The tweet has been retweeted hundreds of thousands of times and likely seen by millions.

What can be done about it? If the public is going to take up broadcasting then we’ll have to try educating the public about the responsibilities of broadcasting. In the meantime I hope that susceptible individuals will shield themselves from triggering messages and get the help they need. I have to imagine that Mr. Williams would have wanted that too.

Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000. Holding privileges at Cedars-Sinai Medical Center, he is also an assistant clinical professor at UCLA's Department of Medicine. This post originally appeared at his blog.

Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness.
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